Gynecological Disorders Practice Questions

Q: Snow storm appearance on ultrasonography is characteristic of which condition?

Hydatidiform mole. **Explanation:** **Hydatidiform Mole (Correct Answer):** The "snowstorm appearance" is the classic ultrasonographic hallmark of a **Complete Hydatidiform Mole**. This appearance is caused by the presence of multiple hydropic (swollen) chorionic villi and intervening intrauterine blood clots. On ultrasound, these appear as a complex intrauterine mass containing numerous small, echo-free (anechoic) cystic spaces, resembling a blizzard or snowstorm. In a complete mole, there is typically no identifiable fetal tissue or amniotic fluid. **Why other options are incorrect:** * **Ectopic Pregnancy:** Typically presents on ultrasound as an empty uterine cavity with an adnexal mass (e.g., "blob sign" or "tubal ring sign") and potentially free fluid in the Pouch of Douglas. * **Anencephaly:** This is a neural tube defect characterized by the absence of the cranial vault. On ultrasound, it presents with the "frog-eye appearance" due to prominent orbits and the absence of the forebrain. **NEET-PG Clinical Pearls:** * **Gold Standard Investigation:** While ultrasound is the initial investigation of choice, the definitive diagnosis is made via **histopathology**. * **Biochemical Marker:** Markedly elevated **serum β-hCG levels** (often >100,000 mIU/mL) are highly suggestive of a molar pregnancy. * **Clinical Presentation:** Patients often present with painless vaginal bleeding ("white currant" discharge), hyperemesis gravidarum, and a uterine size larger than the period of gestation. * **Theca Lutein Cysts:** These are bilateral functional ovarian cysts often seen in molar pregnancies due to high hCG levels; they usually resolve after evacuation.

Q: All are clinical features of Pelvic Inflammatory Disease (PID) except?

ESR - 10 mm/hour. **Explanation:** Pelvic Inflammatory Disease (PID) is an ascending infection of the female upper genital tract. The diagnosis is primarily clinical, based on the **CDC Diagnostic Criteria**, which categorize findings into minimum criteria (required) and additional criteria (supporting the diagnosis). **Why Option C is the correct answer:** PID is an acute inflammatory process. Laboratory markers of inflammation, such as **Erythrocyte Sedimentation Rate (ESR)** and C-reactive protein (CRP), are characteristically **elevated**. A normal ESR (typically 38°C):** Fever is one of the "additional criteria" used to support the diagnosis of PID, reflecting the systemic inflammatory response. * **Option B (WBC count of 15,000/mm³):** Leukocytosis (elevated white blood cell count) is a common laboratory finding in PID, indicating an active infection. * **Option D (Tenderness on movement of cervix):** Also known as **Chandelier Sign**, this is one of the three "minimum clinical criteria" (along with uterine tenderness and adnexal tenderness). Its presence is highly suggestive of pelvic inflammation. **High-Yield Clinical Pearls for NEET-PG:** * **CDC Minimum Criteria:** Cervical motion tenderness, Uterine tenderness, OR Adnexal tenderness. * **Most Common Cause:** *Chlamydia trachomatis* (most common overall) and *Neisseria gonorrhoeae*. * **Gold Standard Diagnosis:** Laparoscopy (shows tubal edema and erythema). * **Definitive Diagnosis:** Endometrial biopsy (endometritis) or Imaging (transvaginal ultrasound showing fluid-filled tubes). * **Fitz-Hugh-Curtis Syndrome:** A complication of PID involving perihepatitis ("violin-string" adhesions).

Q: A 39-year-old woman, para 3 live 3, complains of severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus of around 12 weeks pregnant size, with no adnexal tenderness. Results of endometrial biopsy are normal. What is the most likely diagnosis?

Adenomyosis. ### Explanation **Correct Answer: C. Adenomyosis** **Why it is correct:** Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. The classic clinical triad for adenomyosis is **multiparous women** (usually 35–50 years old) presenting with **progressive secondary dysmenorrhea** and **menorrhagia**. On physical examination, the hallmark finding is a **diffusely enlarged, "globular," and tender uterus**, typically not exceeding 12–14 weeks in size. The tenderness is often most prominent during the premenstrual phase. The diagnosis is clinical, supported by MRI or Transvaginal Ultrasound (showing "venetian blind" shadowing or asymmetrical myometrial thickening), and confirmed by histopathology. **Why the other options are incorrect:** * **A. Endometriosis:** While it causes secondary dysmenorrhea, the uterus is usually normal in size. Findings typically include fixed retroverted uterus, adnexal masses (endometriomas), or tender nodules in the pouch of Douglas. * **B. Endometritis:** This is an infection of the endometrium, usually presenting with acute pelvic pain, fever, and purulent vaginal discharge, rather than chronic progressive dysmenorrhea. * **D. Uterine Sarcoma:** This is a rare malignancy presenting with rapid uterine growth (often post-menopausal) and irregular bleeding. The uterus would be firm and irregular rather than diffusely globular and tender. **Clinical Pearls for NEET-PG:** * **Adenomyosis vs. Fibroids:** Fibroids cause an *asymmetrically* enlarged, firm, non-tender uterus. Adenomyosis causes a *symmetrically* enlarged, soft, tender uterus. * **Definitive Treatment:** Hysterectomy is the only definitive cure. * **Pathology:** Look for the "Halban’s sign" (tender uterus on examination during menstruation). * **Microscopy:** Endometrial islands must be at least 2.5 mm below the basalis layer to be termed adenomyosis.

Q: What is the treatment for partial prolapse in nulliparous women?

Shirodkar sling procedure. **Explanation:** The management of pelvic organ prolapse (POP) in young, nulliparous women focuses on **uterine preservation** and maintaining **reproductive function**. **1. Why Shirodkar Sling is Correct:** In nulliparous women, the primary cause of prolapse is often congenital weakness of the pelvic supports. The **Shirodkar sling procedure** (an abdominal cervicopexy) is the treatment of choice. It involves using a synthetic tape (like Mersilene) to anchor the cervix to the sacral promontory or the anterior surface of the S1 vertebra. This provides strong apical support while preserving the uterus for future childbearing and maintaining vaginal length. **2. Why Other Options are Incorrect:** * **Le Fort Operation:** This is a "colpocleisis" (partial closure of the vagina). It is strictly reserved for elderly, frail women who are no longer sexually active, as it obliterates the vaginal canal. * **Manchester Operation (Fothergill’s):** This involves amputation of the cervix. It is contraindicated in nulliparous women because cervical amputation leads to cervical incompetence, increased risk of mid-trimester abortions, and preterm labor. * **Vaginal Hysterectomy:** This is inappropriate for nulliparous women who desire to retain fertility. It is typically the treatment of choice for post-menopausal women with uterovaginal prolapse. **Clinical Pearls for NEET-PG:** * **Nulliparous Prolapse:** Often associated with conditions like spina bifida, bladder exstrophy, or connective tissue disorders (e.g., Ehlers-Danlos). * **Sling Procedures:** Other abdominal slings include **Khanna’s** (uses fascia lata) and **Purandare’s** (uses rectus sheath). * **Manchester Operation** is best suited for women who have completed their family but wish to retain their uterus (e.g., perimenopausal).

Q: Which of the following organisms can cause cervicitis?

Chlamydia. **Explanation:** **Cervicitis** is the inflammation of the uterine cervix, primarily categorized into ectocervicitis and endocervicitis. **Why Chlamydia is Correct:** *Chlamydia trachomatis* (Serotypes D-K) is the most common bacterial cause of **mucopurulent endocervicitis**. It is an obligate intracellular pathogen that specifically infects the columnar epithelium of the endocervical canal. Along with *Neisseria gonorrhoeae*, it is a major cause of Sexually Transmitted Infections (STIs) leading to Pelvic Inflammatory Disease (PID), infertility, and ectopic pregnancy. **Analysis of Incorrect Options:** * **A. Pseudomonas:** This is an opportunistic pathogen typically associated with nosocomial infections (UTIs or pneumonia), not primary cervicitis. * **B. Staphylococcus:** While *S. aureus* can be part of the vaginal flora or cause Toxic Shock Syndrome (TSS), it is not a recognized primary cause of infectious cervicitis. * **D. Trichomonas:** *Trichomonas vaginalis* primarily causes **vaginitis** and **ectocervicitis**. While it affects the cervix (producing the classic "Strawberry Cervix" or colpitis macularis), it involves the squamous epithelium of the exocervix rather than the endocervical canal. In the context of standard medical examinations, Chlamydia and Gonorrhea are the definitive answers for "cervicitis" (endocervicitis). **NEET-PG High-Yield Pearls:** 1. **Gold Standard Diagnosis:** Nucleic Acid Amplification Test (NAAT) is the investigation of choice for *Chlamydia*. 2. **Clinical Sign:** "Friable cervix" (bleeding on touch/swab) is a hallmark of infectious cervicitis. 3. **Treatment:** Azithromycin (1g stat) or Doxycycline (100mg BID for 7 days). Always treat the partner to prevent reinfection. 4. **Co-infection:** If *N. gonorrhoeae* is detected, always treat for *Chlamydia* empirically.

Question 1

Snow storm appearance on ultrasonography is characteristic of which condition?

Accepted Answer

Hydatidiform mole

Answer

Ectopic pregnancy

Answer

Anencephaly

Answer

None of the above

Question 2

What is the common cause of labial fusion in an adult female?

Accepted Answer

Congenital adrenal hyperplasia

Answer

Fetal exogenous androgen exposure

Answer

Abdominal wall defects

Answer

All of the above

Question 3

Which drug reduces the size of a myoma?

Accepted Answer

All of the above

Answer

GnRH agonist

Answer

Danazol

Answer

Estrogen

Question 4

All are clinical features of Pelvic Inflammatory Disease (PID) except?

Accepted Answer

ESR - 10 mm/hour

Answer

Temperature > 38°C

Answer

WBC count of 15,000/mm³

Answer

Tenderness on movement of the cervix

Question 5

A 39-year-old woman, para 3 live 3, complains of severe, progressive secondary dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus of around 12 weeks pregnant size, with no adnexal tenderness. Results of endometrial biopsy are normal. What is the most likely diagnosis?

Accepted Answer

Adenomyosis

Answer

Endometriosis

Answer

Endometritis

Answer

Uterine sarcoma

Question 6

A 13-year-old girl presents with acute lower abdominal pain. She has a history of cyclical pain for the past six months and has not yet attained menarche. On local genital examination, a tense bulge is seen in the region of the hymen. What is the most probable diagnosis?

Accepted Answer

Imperforate hymen

Answer

Mayer-Rokitansky-Küster-Hauser syndrome

Answer

Testicular feminization syndrome

Answer

Asherman's syndrome

Question 7

What is the treatment for partial prolapse in nulliparous women?

Accepted Answer

Shirodkar sling procedure

Answer

Le Fort operation

Answer

Manchester operation

Answer

Vaginal hysterectomy with posterior repair

Question 8

Which of the following organisms can cause cervicitis?

Accepted Answer

Chlamydia

Answer

Pseudomonas

Answer

Staphylococcus

Answer

Trichomonas

Question 9

What is the recommended treatment for a 16-week hydatidiform mole?

Accepted Answer

Suction evacuation

Answer

Hysterectomy

Answer

Hysterotomy

Answer

Lower segment caesarean section (LSCS)

Question 10

A 52-year-old perimenopausal woman has had vaginal bleeding for a week. She has no medical problems and takes no medications. Hysteroscopy is performed and there is a single, 2-cm, smooth, soft mass protruding into the endometrial cavity. Biopsies are taken. What is the microscopic examination of this lesion most likely to show?

Accepted Answer

Endometrial glands resembling stratum basalis

Answer

Endocervical glands with squamous metaplasia

Answer

Papillae with marked cellular atypia

Answer

Smooth muscle cells in bundles

Gynecological Disorders — MCQs

Gynecological Disorders — MCQs

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